Sunday, February 8, 2015

ACA / Obamacare : You Can't Handle the Truth

Now Jerry and Hiram have been having a long winded debate regarding ACA / ObamaCare.  G2A SS Disability

Jerry then made this outrageous comment that I think is very incorrect. "No, and Obamacare is the prime example. Every criticism that Republicans made has proved true, and almost every promise of Obamacare has been broken."

Now I am not a big ACA proponent, especially with regard to how much money was spent on setting up, marketing and operating the "market places".  And the wealth transfer aspects of it are not what I would prefer in our capitalistic country.  However it has accomplished much of what was intended:
  1. Health insurance costs lower income people less due to the expansion of Medicare and the premium subsidies that they are receiving. (ie tax credits)  Of course I am not happy that people like myself are paying more to fund this, but one can not get money out of those who have little.
  2. People with "pre-existing conditions" can now get insurance with somewhat reasonable premiums, and children can stay on their parent's plans longer. Of course this is costing us all a bit more, the insurance company actuaries need to adjust rates to cover these previously not covered situations.
  3. People get insurance policies that meet a minimum standard of coverage.  Again, we pay a little more if the benefits increased due to this.
Though Jerry likely disagrees, I think the primary purposes of ACA were to increase the number of people with health insurance (private or public), encourage more people to use preventive care, improve the quality of the low end insurance policies and stop insurance companies from dropping people just because they got seriously sick.

Now I agree that this has been an expensive way to pursue these worthy goals, and it has limited the choices of some people. (ie high deductible policies, doctor choices, etc)  However, I don't see the GOP offering any better option.  That is other than wishful thinking that somehow charities will take care of the medical bills for all the poor and unlucky in the USA.

48 comments:

Anonymous said...

Obamacare might have been done it ways that put more pressure on costs. Whether that would have been possible is something we can't really know because we can't predict with any degree of certainty where paths not taken will bring us.

Republicans believe that the creation of transparent market places where insurers compete with each other will result in lower premiums. For a lot of reasons, I am skeptical of that view, but because Democrats wanted to get a deal done, they accepted that market based approach. As it turns out, Democratic skeptics of a market based approach turned out to be right. You can tell because Republicans are claiming the premiums, the result of their approach to health care costs, are too high. While it might not be the case that all Republican criticisms of Obamacare are valid, certainly there is much validity to criticisms of the outcomes of a market based approach. But what Republicans are criticizing is in fact a Republican idea.

--Hiram


John said...

I think Republicans are criticizing the fact that:
- middle and upper income folks are paying more to subsidize the healthcare costs of lower income folks. (ie wealth transfer)
- the contents of policies are controlled by the government and some people were forced to change insurers, doctors, etc. (loss of personal control)

More pressure on cost? I assume you are proposing that single payer would have done this...

The idea of big brother and public employee unions having absolute control over my individual healthcare sounds bad on so many levels. Even if they miraculously found a way to keep costs down, I couldn't even imagine the poor quality, poor availability, etc that would result.

Laurie said...

do you expect to be on medicare one day? none of my relatives have complaints about it.

Anonymous said...

middle and upper income folks are paying more to subsidize the healthcare costs of lower income folks. (i

Oh sure, but that's mostly after the fact quibbling about the terms of a deal. That can happen after any deal. If rich folk wanted a better deal for themselves, they should have come to the table and negotiated for themselves more effectively.


More pressure on cost? I assume you are proposing that single payer would have done this...

That's one way that might have done it. I don't know if it would have or not, but the standard arguments against won the day, so we continue to have out of control costs. As you point out, the trade off was for higher quality health care, something for which, I guess Democrats aren't to get credit for. If we had focused on cost instead of quality no doubt Republicans would have criticized us for that.

--Hiram

Anonymous said...

I have spent a lot of time over a number of years thinking about how we price things. There was a recent Wall Street Journal op ed piece about the extraordinarily high prices of intro econ textbooks. One commonly used textbook costs 250 dollars new, and not that much less used. The writer argued the high price was due to the fact that the professor of the course who assigned the text didn't have to buy it himself and was therefore insensitive to pricing issues. But to me, there was a pretty obvious flaw in that reasoning. The English professor next door might assign his class "Oliver Twist". Like the econ prof, he was insensitive to pricing pressures; he already owned a copy, yet in the marketplace, Oliver Twist sells on Kindle for free. In both cases the profs were indifferent to price, why the difference?

I think some of the same considerations apply to health care markets. The econ prof partly blamed government for the disparity, Big Brother, in Orwellian terms. What role did BB play? Was it BB's decision to assign the texts? If BB was the x factor in both cases why were the pricing outcomes so different? And is the role played by BB in text book prices similar to the one it plays in health care pricing? Should we object to it?

--Hiram

jerrye92002 said...

We've been over this. The primary purpose of the ACA was to realize the liberal pipe-dream of socialized medicine without making it obvious. The good intentions that paved the way for it were simply lies, the Devil's best tool.
1. increasing the number of people with health insurance was a bogus aim, because 54 million of the supposed 45 million uninsured did not need, or did not want, or were not eligible for, health insurance. Not only that, but having health insurance does not offer you health CARE unless the number of providers is somehow increased, and the opposite is now taking place.
2. To "encourage" more people to use preventive care, you need to allow innovation, not rigid government controls, of health insurance such that such encouragement takes place. I had such a plan, until Obamacare wiped it out.
3. "Improving the low end insurance policies" is not a job for bureaucrats and their arbitrary decisions about what people need and want and are willing to pay for. They should have allowed anyone that wants one to have an HSA or alternative insurance policy that THEY chose. MORE people would have become insured if they were offered, in the free market, something they could afford.
3. A lot was made about insurance companies arbitrarily dropping people "when they got sick." But Obamacare is forcing people off their insurance BEFORE they get sick. I'm not seeing how that is better. I'm also not believing that private cancellations were a serious problem before, because insurance policies are contracts, enforceable by law.
4. As for pre-existing conditions, there were already solutions for that problem, too. Many states had high-risk pools, and many insurance companies offered policies with pre-existing condition waivers or waiting periods to make the insurance affordable. The ACA presumes that everybody with health insurance can take out more in benefits than they pay in premiums. And why would anybody pay premiums if they can simply buy insurance WHEN they get sick? I think that's a bit unrealistic, but it's now the law.

The GOP has a better option, as I've said. Repeal the ACA and stop making things worse. Beyond that, there are several things that could have been done to make things better, but Democrats adamantly refuse to even consider them. They reject any sane reality, and substitute their own.

Anonymous said...


The GOP has a better option, as I've said.

Well, no, they really don't because Obamacare is largely a GOP plan. Republicans haven't provided an alternative, because no alternative consistent with their previously stated principles can differ enough from Obamacare to matter.

--Hiram


jerrye92002 said...

"Obamacare is largely a GOP plan" You keep saying that, but you have never explained why not a single Republican voted for it, and why they continually vote to repeal it. Even if it contains Republican "ideas," it is implemented so badly as to prevent any good from coming from it.

Sean said...

"You keep saying that, but you have never explained why not a single Republican voted for it, and why they continually vote to repeal it."

Politics. It's easy to vote against something you know is going to pass and it's easy to repeal something you know will never actually be repealed.

Particularly when the vote is largely irrelevant (for the House, in 90%+ of the cases) to your electoral future.

Sean said...

"They should have allowed anyone that wants one to have an HSA or alternative insurance policy that THEY chose. MORE people would have become insured if they were offered, in the free market, something they could afford."

You do realize that in the decade between the introduction of HSAs and the start of the individual mandate, the percentage of people insured went down, right?

Also, there's a perfectly rational reason for not allowing people to buy junk insurance policies. When government has the role of the insurer of last resort, it's in everyone's interest to make certain that we're not allowing free-riders on that responsibility.

Sean said...

"And why would anybody pay premiums if they can simply buy insurance WHEN they get sick? I think that's a bit unrealistic, but it's now the law. "

That's not how it works. If you're outside the open enrollment period, you have to wait until the following January 1 (if you intend to get a subsidy, anyway).

John said...

I will be interested to see if the GOP will ever offer a better alternative.

I mean ACA at it's simplest is a sliding fee scale for health insurance, with intrinsic motivational techniques to get people to sign up.

Anonymous said...

will be interested to see if the GOP will ever offer a better alternative.

I firmly believe there will never be anyone offering an alternative that is undisputably better. I certainly think the GOP is capable of offering legislation that would improve Obamacare, which might also get widespread support. I don't think the GOP will in the foresseable future offer an alternative to Obamacare, because I don't think it's possible for them to give us a plan consistent with their stated principles that differes significantly from Obamacare. They prefer the status quo where they can take potshots at Obamacare without worrying about whether their attacks are consistent with their own plan.

--Hiram

jerrye92002 said...

"...ACA at it's simplest ..."

There is absolutely nothing simple about the 2200 pages of the ACA, or the 25,000 pages of regulation that has been added to it. All this byzantine complexity does is to increase the opportunity for unintended consequences, of which there have been many. Most all of those were foreseen, except by those blinded by the ideology.

jerrye92002 said...

Then I will expect expressions of surprise and delight when the official GOP "replacement" is unveiled next month. Personally, I would be happy to just repeal that monstrous ACA and be done with it.

John said...

I for one will be surprised to see it. How to make healthcare affordable for lower income households without some form of wealth transfer seems impossible?

And it would mean that the GOP politicians would need to be somewhat united for once. This seems unlikely, especially with the candidates pushing fringes.

Anonymous said...

As I understand it, Republicans are under some pressure to come up with a health care plan in light of King v. Burwell. The feeling is that the Supreme Court would be more willing to overturn Obamacare if some sort of plausible argument could be made that their action wouldn't throw the nation's health care system into chaos. And while there isn't and hasn't been an alternative to Obamacare proposed by the Republican majority in the House, and now the the Congress, that's not to say there are no Republican plans out there. A couple of Republican senators recently issued a sort of cut and paste version of Obamacare lite, and Bobby Jindal sent out a plan not so long ago, which mostly sank without a trace.

The problem has never been with putting together a plan. The issue is pretty simple really. The problem is getting it passed, and that's where the intricacies, the thousands of pages of text and regulation come in, as various constituencies are placated.

--Hiram

John said...

Jerry,
I stole this from the SS post.

"we have seen the terrible consequences of that terrible legislation."

What again are these terrible consequences? As far as I can tell, costs are up for some and down for others. Insurance stability is up for some and down for others. Many low income and pre-existing folks can now afford health insurance. The government spent a small fortune setting up exchanges and marketing them.

What am I missing?

jerrye92002 said...

Here's one take:
http://dailysignal.com/2013/07/08/morning-bell-obamacares-dirty-dozen-implementation-failures/

I prefer to think of it in terms of promises broken.
– The Big Lie was "if you like your plan you can keep your plan." Millions of people lost their health insurance plan and millions more will lose their plan as time goes by.
– We were promised that costs would go down by "$2500 per family" but costs have gone up by double digits for everybody. You can't count people whose costs went down because they receive taxpayer subsidies; SOMEBODY is paying those costs.
– Supposedly those 35 million or 45 million people would all have access to affordable care – that's why they called it that. But if you don't count those who had insurance before and lost it, and those who were already eligible for Medicaid, and those who could have afforded a low-cost policy but didn't, you end up with about one or 2 million people actually "benefiting" by having health insurance under the ACA. And of course that still does not get them health CARE.

And here's a better list:
http://www.heritage.org/research/reports/2013/12/10-broken-obamacare-promises

Anonymous said...

"I prefer to think of it in terms of promises broken."

It's impossible to predict accurately what the result of any complex policy initiative will be. Statements about the future will always turn out to be wrong. That being the case, is our inability to predict the future a sufficient reason not to engage in complex policy initiatives?

--Hiram

Sean said...

"Millions of people lost their health insurance plan and millions more will lose their plan as time goes by."

Every Republican plan that has gone up as a trial balloon so far would carry the same risk.

"We were promised that costs would go down by "$2500 per family" but costs have gone up by double digits for everybody. You can't count people whose costs went down because they receive taxpayer subsidies; SOMEBODY is paying those costs."

The rate of medical inflation in 2014 was the slowest it has been since 1964, which would indicate that there is some bending of the cost curve going on.

jerrye92002 said...

"...is our inability to predict the future a sufficient reason not to engage in complex policy initiatives?"

Absolutely. Any d@mn fool can write legislation based on wild promises and good intentions. And they too often do.

jerrye92002 said...

"The rate of medical inflation in 2014 was the slowest it has been since 1964..."

Easy to bend the cost curve down if people get thrown off of insurance, or have it but with new, higher copays, of if government engages in price controls. That, of course, means fewer doctors willing to accept patients, and lower quality care. I would rather pay more, and live better.

Anonymous said...


Absolutely.

And that's where the fundamental disagreement lies. My favorite video on this, something of a litmus test on this is , "Wait and See". https://www.youtube.com/watch?v=2tw688Kbjy4

Republicans look at this video and think, "of course the future is unpredictable, let's sit tight and hope nothing bad happens." Democrats look at this video and think, it's the bueiness, by doing nothing by remaining passive, which is making the high risk choice.

--Hiram

Sean said...

"have it but with new, higher copays"

Isn't that a critical part of the conservative health care agenda? That was the whole HSA deal -- save money tax-free and pay at least a portion out of pocket from dollar one so you have a consumer incentive to consume health care rationally?

jerrye92002 said...

"Democrats look at this video and think, it's the bueiness, by doing nothing by remaining passive, which is making the high risk choice."

Democrats don't need a video to convince themselves that they are so morally and intellectually superior to the rest of us that they can write a law that overcomes the laws of supply and demand, the laws of human nature, the law of unintended consequences, and the laws of math and science. They are like the Captain of the Enterprise, saying "make it so." In short, they are delusional.

Yes, sometimes you have to take risks to do something important, but you should not overlook the obvious pitfalls that attend. For example, Congress KNEW millions would lose their health insurance. Did they prevent that? No. They KNEW most people about to be covered were already eligible for Medicaid but didn't participate. Did they improve that program first? No. They KNEW costs would go up, but did they care or make provisions that would have held costs down? Of course not. It's all about the good intentions wishing it to be so.

jerrye92002 said...

"Isn't that a critical part of the conservative health care agenda? That was the whole HSA deal..."

That is correct, but with one critical difference. Those who had insurance and suddenly found themselves forced into a higher-copay situation are going to react to that by getting less care than they did before. Those who CHOOSE an HSA are choosing those higher co-pays, and are willing to decide for themselves when they need care, and when not. It's the same old "who decides" situation.

Sean said...

Congress didn't improve Medicaid? That's absurd. They substantially improved Medicaid, but many conservative governors chose not to go along.

"Those who had insurance and suddenly found themselves forced into a higher-copay situation are going to react to that by getting less care than they did before."

Republican health care reform policies have the same exact risk.

Anonymous said...


"Democrats don't need a video to convince themselves that they are so morally and intellectually superior to the rest of us that they can write a law that overcomes the laws of supply and demand, the laws of human nature, the law of unintended consequences, and the laws of math and science."

What's fascinating in that video is how small a role the laws of supply in demand played in the executive's decision making. Note that in the video, business is improving, evidently the demand for whatever the company produces in increasing. But the CEO simply ignores that out of fear of an unknown future. What's even more ironic is that the executives she cites, Gates and Buffett, were famous for pretty much ignoring economic conditions and striking out firmly in an always unknown future.

The world is full of unintended consequences. Sometimes I wonder if there is anything else. If they were subject to some of law, it would be harder to argue that the consequences were unintended.

None of us know what the future will bring. If we insist on foreknowledge before acting we would never act at all.

--Hiram

jerrye92002 said...

"If we insist on foreknowledge before acting we would never act at all."

On the other hand, if we insist on denying what we know, in pursuit of some ideological but unrealistic objective, we SHOULD NOT act. Better to do nothing than to do the wrong thing.

jerrye92002 said...

"Republican health care reform policies have the same exact risk. "

I thought Republicans didn't have any proposals? Anyway, it's unreasonable to lump all such real or imaginary proposals together and say they are exactly the same. The biggest problem with your statement is that it completely overlooks the question of "who decides." Republican proposals might raise co-pays, but be part of a program of consumer choice. Those who wanted low/no co-pays could pay for that additional coverage. With Obamacare such choices exist, too, but start at an arbitrary distance from the marketplace.

Anonymous said...


I thought Republicans didn't have any proposals?

Actually, and I want to be very clear on this point, many, many Republicans have proposals. Obamacare, after all Obamacare is essentially a Republican program. Recently, some Republican senators made some health care proposals. Bobby Jindal recently issued a comprehensive health care plan. We have talked about these issues for decades now, and there has never, ever been a shortage of plans or ideas. What has been missing, is in fact missing now, is the political will to enact health care legislation within a system designed to hinder political action.

--Hiram

jerrye92002 said...

"...a system designed to hinder political action."

In that case, I wish it worked better. congress should not be taking POLITICAL action. They should be solving problems they are Constitutionally entrusted to solve, and certainly not making those problems worse in pursuit of some political objective.

Sean said...

"I thought Republicans didn't have any proposals?"

They don't have one that they can pass in either chamber of Congress.

"Anyway, it's unreasonable to lump all such real or imaginary proposals together and say they are exactly the same."

The most prominent plans offered so far (by Jindal and Sens. Hatch and Burr) would displace people off the insurance they currently have today. Whether it's by loosing the restrictions on insurers or changing the tax treatment of insurance or reducing the subsidies or several other provisions found in one or both of said proposals.

"With Obamacare such choices exist, too, but start at an arbitrary distance from the marketplace."

Health care isn't like cereal, and it shouldn't be treated as such, unless you're willing to deliver the possible negative externalities that come along with it (such as letting folks who don't have insurance go without care).

Anonymous said...

In that case, I wish it worked better. congress should not be taking POLITICAL action.

It has worked remarkably well. The reason why, unlike every other industrialized country in the world is that we have a political system designed to prevent the government from doing things. The effectiveness of that system was interrupted only for the briefest period of time, and now we are back to the old system of governmental institutional inaction.

--Hiram

jerrye92002 said...

"Health care isn't like cereal, and it shouldn't be treated as such..."

That's not correct. We aren't even talking about health CARE, but health INSURANCE. Having any kind of insurance does not guarantee you care for what ails you. It doesn't even grant you access to a doctor. And it IS like cereal, in that you should be paying for what you choose to use, because the alternative is asking the provider to give it to you for free and nobody is going to spend 7 years of schooling to work for free. You used to, of course, be able to get charity care, until government got involved.

I am willing to let people who CHOOSE not to have health insurance do without care, or to pay for it without insurance, or to ask for charity, as they CHOOSE. I simply do not accept the notion that unless I am forced to pay exorbitant sums for my health insurance AND somebody else's, that I am somehow condemning them to an agonizing death. THEY have a responsibility that must be exercised.

jerrye92002 said...

"...now we are back to the old system of governmental institutional inaction."

Unfortunately, there are a great many things that our "brief period" of one-Party control created that need to be UNDONE, and our deadlock is preventing that from happening. Will Rogers said we're the only democracy in the world where we have to wait four years for better, regardless of how bad it gets. He's wrong; we've had six, so far.

Anonymous said...


Unfortunately, there are a great many things that our "brief period" of one-Party control created that need to be UNDONE

Well,for better or worse, that can't happen because the government can't act.

--Hiram

Anonymous said...

Will Rogers said we're the only democracy in the world where we have to wait four years for better, regardless of how bad it gets.

Kind of a curious statement. We do have elections every two years. In Britain, Parliaments last, at most, five years except during war time. The Parliament that was seated during WW II had been elected in 1935.

--Hiram

jerrye92002 said...

And on the other hand, we shouldn't want to be like Italy, where multi-party coalitions rise and fall like the tides and the country lurches this way and that. Not only can they not agree on what the right thing to do might be on any given issue, but their system is geared towards allowing the wrong thing to be pursued briefly, followed by the opposite wrong thing.

What keeps our system stable, if moribund, is the two party system. Neither can stray too far from the center and a majority in one of the three, or even two of the three, does not permit wild policy swings. Unfortunately having all three-- Senate, House, Presidency-- does. And depending on who holds all the levers, that can be a bad thing. If only, as Will Rogers said, "somebody that knows something would come along."

Anonymous said...

we shouldn't want to be like Italy, where multi-party coalitions rise and fall like the tides and the country lurches this way and that. N

Every form of government has it's own problems. As it happens we are more like Italy than we would like to be since in Congress as in the Italian Parliament there are multiple factions within each which must be pleased in order to get anything done.

Republicans are great believers in process type solutions. They believe that the right process will achieve the right result, and that the wrong process will achieve the wrong result. For example, one argument you often see made about Obamzcare is that it is a bad program because it was enacted in ways that were procedurally flawed. One example of that is the argument that it's a bad law because not enough Congressman read it, and it should be repealed on that basis. As much as I find that argument strange, Republicans see no problem at all with it, indeed are incapable of seeing how Democrats and others find it anything other than convincing.

--Hiram

jerrye92002 said...

Perhaps you are correct. Republicans, and most rational people, find it very difficult to understand how Democrats can procedurally "push through" complex legislation that they haven't read, don't understand, and that is unanimously opposed by the opposition (thinking man's) party. It isn't that the process was "flawed," it is that the process was used to produce an irredeemably flawed result.

Anonymous said...

"Republicans, and most rational people, find it very difficult to understand how Democrats can procedurally "push through" complex legislation that they haven't read, don't understand, and that is unanimously opposed by the opposition (thinking man's) party."

I think it's the case that pretty much all legislation Congress passes isn't read by Congress people. The process of passing such legislation is well established.

I do think most Americans understand that the principles behind majority rule. Are you really claiming that Republicans don't? Do you wish to establish as some sort of "fixed principle" that all legislation, in order to be passed, must receive at least one vote from each party in Congress. There isn't such a rule now.

--Hiram

jerrye92002 said...

There isn't a rule, but when you haven't read it and don't know what's in it, and the other side is unanimous in telling you it's crap, shouldn't you pause just a little bit and wonder what they know that you don't? Seems to me that, even in Congress, there should be a bit of common sense on display from time to time.

Anonymous said...

There isn't a rule, but when you haven't read it and don't know what's in it, and the other side is unanimous in telling you it's crap, shouldn't you pause just a little bit and wonder what they know that you don't?

I haven't read it either, and I paused quite a bit. Obamacare has not shortage of flaws that are very well understood. My first choice would have been to go in a fundamentally different direction. But this lousy bill was the one that we could vital Republican constituencies to support.

Bear in mind always, that Republicans are attacking Obamacare for not doing things they oppose. A Republican version would be subject to the exact same objection republicans now are putting forward about Obamacare.

--Hiram

jerrye92002 said...

It's always amusing when you try to tell me what Republicans think, believe, or would do, because I don't know any Republicans that would agree with your portrayal of them.

Why not just say, "Obamacare has not shortage of flaws that are very well understood." and quit there? Then we can move on from that truth to some sort of solution.

Anonymous said...

when you try to tell me what Republicans think, believe, or would do, because I don't know any Republicans that would agree with your portrayal of them.

but that's the problem isn't it? Republicans won't agree with my portrayal of them, but they won't provide their own versions of themselves. That's why straw man tactics are necessary, and by the way effective. They fill in the political vacuum Republicans create for themselves, in lieu of proposing policy.

--Hiram

jerrye92002 said...

Well, you have a point there. Republicans have the problem of having too many solutions but no way of communicating (thanks to the major media's bias) how any of them are better than what we have now. Democrats have the advantage of single-minded bally-hooing of whatever comes along first.